Research On The Performance Of Government Health Expenditures Under The Background Of Equalization Of Basic Public Services

The equalization of basic public health services is a requirement for ensuring the health of Chinese citizens and promoting comprehensive human development.In 2017,the State Council issued the "Thirteenth Five-Year Plan" to promote the equalization of basic public services.The"Fourteenth Five-Year Plan" in 2021 proposes the goal of achieving a new level of people’s well-being,a significant improvement in the level of equalization of basic public services,and a more perfect health system.However,problems such as low efficiency of public health expenditure and uneven distribution of public health resources still exist.At the same time,China’s economic growth rate is in a slow decline,and local government tax revenue will also correspondingly decrease various fiscal expenditures.Therefore,at present,it is necessary to explore how to maximize output under a certain level of fiscal revenue,improve the efficiency of health expenditure,and ensure the realization of the goal of universal health and equalization of public health services.Based on this reality,this article takes the 31 provinces of China from 2005 to 2021 as the research object.Evaluation indicators are selected from the short-term resource output and long-term benefit output of medical and health investment.Based on a two-stage perspective and using an improved network EBM model,the comprehensive efficiency and sub-stage efficiency of health expenditure in 31 provinces and cities in China are calculated and analyzed.The overall situation of China and the three major regions of East,Central,and West are compared with weighting.The impact of representative indicators of economy,government,population,and marketization on health expenditure efficiency is explored using a panel fixed effect model.The fairness performance of regional medical and health expenditure is measured using the Theil index method.The study shows that:(1)The first-stage efficiency value of China’s medical and health expenditure is lower than the second-stage efficiency value,indicating that there is greater room for optimization and improvement in the efficiency of government medical and health expenditure transforming into actual medical supplies and services.The efficiency of medical and health expenditure shows an east-high-west-low pattern,and the efficiency performance in the central and western regions fluctuates greatly,which dominates the change of the national efficiency value.(2)Fiscal expenditure decentralization,population dependency ratio,and the impact of the COVID-19 pandemic have a significant negative impact on the efficiency of medical and health expenditure,while per capita GDP and urbanization level will significantly improve the efficiency of medical and health expenditure.There is no significant relationship between the level of marketization,education level,and the efficiency of medical and health expenditure.(3)Overall,the fairness of medical and health expenditure in China is good at the current stage.Through decomposition analysis of Theil index,it is found that the imbalance of regional medical and health expenditure is mainly caused by regional differences.The balance degree of medical and health expenditure,the number of hospital beds,and the level of health technology personnel have been improved in the long term,but the imbalance of the number of medical and health institutions is relatively serious.(4)Per capita GDP and disposable income are significantly negatively correlated with the Theil index of medical and health expenditure,while fiscal expenditure decentralization,population density,and education level are significantly positively correlated with the Theil index of medical and health expenditure.There is no significant relationship between the level of marketization and the Theil index of medical and health expenditure.